HomeMy WebLinkAboutScan_Doc0345ALL APPLICABLE INFO MUST fiE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:_Permit Number:_
Building Permit Application
Planning and Development Services
Building and Code Regulation Eivision
2300 Virginia Avenue,Fort Piet-te FL 34982
Phone:(772)462-1553 Fax (772)462-1578 Commercial ----Residential ----
PERMIT APPLICATION FOR:To Select from dropbox,click arrow at the end of line
Address:3500 'TlcJHi ~e.s j~(l 163
Legal Description:_La ke&Q.oceVU \GSccff (Y\e.u deL vx0....fu&e.,L~'3Q}.2
ll,~~~~3~_
Property Tax 10 #:\3~\..1.6 l\-(0)S ~C>C:D-'-0 Lot No._
Site Plan Name"£~'Cf Se.n Block No._
Project Name:a'CrS '....P"o<---L _
Setbacks Front _Back:Right Side:Left Side:_
o Windows/DoorsDRoofI I Roof pitch
Total Sq.Ft of Construction:._~-__="..__---
Cost of Construction:$-<{9tJ(),9l
SCfl!;of First Floor:
Utilities:USewer D Septic Building Height:_
Name (If':t-ec.sen
Address~~~,,~Terr.JfJQO
City:B-t.13«(~State:Yt-
Zip Code:'649S'(.Fax:_
Phone No.l,l02 -q~:::=.l~~fi..L..L./_
E-Mail:_
Fill in fee simple Title Holder on next page (if different
from the Owner listed abuve)
Name:~'l>erJo..;hn~
Company:IliL-Arned Cbn At f:U~i(,..
A?dr~s:~/l~meaodz/e (.
City:'./-,t A-State:&
Zip Code:3te P{p Fax:,7;)-f')~-5/YLf
Phone No.'J::2 -g];;"'51'13
E-Mail:~boob @ o'tlfielnL Con
State or untyLicense:!3f1e 057945
If value of construction is $2_;00 or more,a RECORDEDNotice of Commencementis required.
DESIGNER/ENGINEER:_Not Applicable
Name:_
Address:_
City:State:
Zip:Phone _
MORTGAGE COMPANY:
Name:Addres-s-:-----------------
City:~--------.State:Zip:Phone:_
_Not Applicable
FEE SIMPLE TITLE HOLDER:_Not Applicable
Name:_
Address:_
City:-=-:-__,,_
Zip:Phone:_..-----------
_Not ApplicableBONDINGCOMPANY:
Name:_
Address:------------------City:_
Zip:Phone:_
STATE OF FLORIDA ?5 -COUNTY OF (T:L.UCxe.,
The forgoing instrument was acknowledged before me
this __day of -'20_by
S}Gvn~J)t~~h~D~'~L~,-----
Name of person maL~statement
Personally Known )<OR Produced Identification
Type of Identification
Produced _
'--..---''----l
OWNER/CONTRACTOR AFf:IDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any appl cable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting )f this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance with the approvec:plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit ap plications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:YOlJrfailure to Record a Notice of Commencement may result in your paying twice for
improvements to your pro aertv.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection.If you intend to obtain financing,consult with lender or an attorney before
commencin work or recordin our Notice of Commencement.
-~
Sign~~r/License Holder
STATE OF FLO~~"COUNTY OF :-r.l.U G\re.,
The forgoing instrument was acknowledged before me
this __day of ,20_by
-:::s-Ct..m-e.s.~;h /)A,.,
Name of person ma -g statement
Personally Known Xi OR Produced Identification _
Type of Identification
Produced _
(Signature ~J~~v~!1>!)'PubJic-GltiiIte ~tt)ffifu ).
j •.'~o'.e<~~Notary PubliC -State 01 Flonda
Com mis'ca ·i Commission #FF91~~1a1)
\~Y4~MyComm.Expire.Oct6.2019
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SEA TURTLE
REVIEW
ZONING
REVIEW
SUPERVISOR PLANS VEGETATION
REVIEW REVIEW REVIEW
REVIEWS MANGROVE
REVIEW
DATE
RECEIVED
FRONT
COUNTEFl
DATE
COMPLETED
Rev.8/2/17